Your Role The Pharmacy Services Prior Authorization team conducts medical necessity reviews for drug coverage. The Pharmacist Manager will report to the Pharmacist Senior Manager, Pharmacy Benefit Prior Authorization. In this role, you willsupport the Blue Shield of California Pharmacy and Therapeutics (P&T) Committee process by ensuring that evidence-based clinical decisions are implemented operationally to support safe, efficacious, and cost-effective prescribing of medications. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.s the right way, and fostering continuous learning.Your Work In this role, you will: Provide oversight for the management of program area operations and employeesBe responsible for promotion and execution of overall vision, goals, objectives of the business unitProvide oversight for the coordination of activities of the program area with other business units and monitor operational statistics to ensure all respective accreditation, regulatory and compliance requirements are metProvide oversight for the development, implementation, coordination, and assessment of programs to improve quality and cost-effectivenessDemonstrate leadership principles daily and ensure team actions are in place to make Blue Shield a great place to workRegularly monitor program data and metrics to evaluate program effectiveness and outcomes; reports to appropriate committees, managers, and other internal or external stakeholdersSupport other teams within and outside of the Pharmacy Services department with subject matter expertisePrecept Pharmacy Practice Residents and students, as assigned. Maintain required residency program documentation and meet standards for preceptorship.Your Knowledge and ExperienceRequires a Doctor of Pharmacy (PharmD) degreeRequires at least 5 years of experience in a managed care setting, including at least 3-5 years of management experience or equivalentRequires an active and unrestricted California Registered Pharmacist (RPh) licenseDemonstrates thorough knowledge regarding therapeutic use of drugsUnderstands basic management approaches such as work scheduling, prioritizing, coaching and process execution, work organization, risk management and delegationExperience in leading and managing the execution of processes, projects, and tacticsDemonstrates critical thinking and effective decision-makingAdvanced skills analyzing data to make business decisionsPay Range:The pay range for this role is: $ 118800.00 to $ 178200.00 for California.Note:Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.#LI-MM4

General information City: Van Nuys State: California Team Clinical Services Working time Full- Time Description & Requirements Description Sign-On Bonus:$750Compensation: $26 - $32 Per Hour-Full time, based upon experiencePromotion opportunity to Program Supervisor (salaried) based upon experienceBenefits of Working at Intercare:Monthly Bonuses!Flexible work schedule with a focus on work/life balance; Manage your own scheduleMileage reimbursement, a company computer and cell phoneEducation tuition reimbursement program (Masters & BCBA)!Leadership training and CEUs - we will teach how to become a better leader!Medical, Dental, and Vision insuranceGenerous time off policy (vacation, sick time, and holidays)Company 401k PlanOutstanding mentorship and supportive environment for continual learningRequired Credentials/Experience:Completed Master’s degree in relevant fieldIn progress with BCBA preferredStrong ABA and clinical skillsExcellent written and spoken communication, time management skills, and interpersonal skillsAbility to give and receive constructive feedback with a team player attitudeBilingual skills valuedJob DescriptionIntercare Therapy provides evidence-based behavioral therapies that help children overcome challenges related to autism spectrum disorders. Our mission is to optimize the independence and quality of life of our clients and their families. We love what we do, and we are seeking team members who share our passion for improving the lives of children and families affected by autism.AProgram Managerserves in the field as the onsite case supervisor and leader, mastering daily case management skills, including developing and overseeing clinical programs, supervising BIs and providing education and training for client caregivers. You must be willing to drive 30 to 60 miles a day, andable to supervise client sessions anytime between 8AM and 6PM on weekdays, and occasionally on weekends.We are proud to be the highest rated established ABA organization on Glassdoor! Check out our rankings and reviews on Glassdoor!Learn more about us on You Tube!This position may require the candidate be fully vaccinated for COVID-19 in accordance with all vaccination requirements set forth by Intercare funding sources and pursuant to any guidelines from the California Department of Health.Closing:If you have experience in any of the following fields, we encourage you to apply:Behavior Analyst, Autism, Social Learning, Social Skills, Developmental Condition, Psychology, Sociology, Social Services, Children, ABA, Applied behavior analysis, BCBAIntercare Therapy will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the Los Angeles Fair Chance Initiative for Hiring (Ban the Box) Ordinance.Intercare Therapy supports a diverse workforce and is an Equal Opportunity Employer.

Schedule is Mon-Fri 10am-7pm The Behavioral Health Registered Nurse Case Managerwill report to the FEP Department Manager. In this role you will determine, develop, and implement a plan of care based on accurate and comprehensive assessment of the member’s needs. The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians.Your WorkIn this role, you will:Coordinates care for Lower Level of Care such as Residential Treatment, Partial Hospitalization Program, Intensive Outpatient Program, other outpatient services, and community programs as appropriateResearch and design treatment/care plans to promote quality of care, cost effective health care services based on medical necessity complying withcontract for each appropriate plan typeProvide Referrals to QualityManagement (QM), Disease Management (DM) and Appeals and Grievance department (AGD)Recognize the clients right to self-determination as it relates to the ethical principle of autonomy, including the client/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare teamDesign appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access and cost-effective outcomesInitiate and implement appropriate modifications in plan of care to adapt to changes occurring over time and through various settingsApplies detailed knowledge of FEP PPO and Blue Shield of California's (BSC) established medical/departmental policies, clinical practice guidelines, community resources, contracting and community care standards to each casePerforms effective discharge planning and collaborates with member support system and health care professionals involved in the continuum of careProvides disease management education on core chronic conditions (Diabetes, Heart Failure, COPD, Asthma and Coronary Artery Disease)Determines, develops and implements a plan of care based on accurate and comprehensive assessment of the member's needs related to behavioral healthMust be able to sit for extended periods of time and read information on one computer screen and apply that information on a second computer screen to complete documentationYour Knowledge and ExperienceBachelor of Science in Nursing or advanced degree preferredRequires a current CA RN LicenseCertified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirementsRequires at least 5 years of prior experience in nursing, healthcare or related field3+ years managed care experience preferredRequires relevant behavioral health experienceComprehensive knowledge of case management, discharge planning, utilization management, disease management and community resourcesAble to operate PC-based software programs including proficiency in Word and Excel.Strong clinical documentation skills, independent problem identification and resolution skillsStrong supervisory, communication, abstracting skills with strong verbal and written communication skills and negotiation skillsCompetent understanding of NCQA and federal regulatory requirementsKnowledge of coordination of care, prior authorization, level of care and length of stay criteria sets desirableDemonstrates professional judgment, and critical thinking, to promote the delivery of quality, cost-effective care. This judgment is based on medical necessity including intensity of service and severity of illness within contracted benefits and appropriate level of careDemonstrate leadership, project management and program evaluation skills and ability to interact with all levels including senior management and influence decision-makingPay Range:The pay range for this role is: $ 87230.00 to $ 130900.00 for California.Note:Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.#LI-MM4

General information City: Van Nuys State: California Team Clinical Services Working time Full- Time Description & Requirements Description Sign-On Bonus:$750Compensation: $26 - $32 Per Hour-Full time, based upon experiencePromotion opportunity to Program Supervisor (salaried) based upon experienceBenefits of Working at Intercare:Monthly Bonuses!Flexible work schedule with a focus on work/life balance; Manage your own scheduleMileage reimbursement, a company computer and cell phoneEducation tuition reimbursement program (Masters & BCBA)!Leadership training and CEUs - we will teach how to become a better leader!Medical, Dental, and Vision insuranceGenerous time off policy (vacation, sick time, and holidays)Company 401k PlanOutstanding mentorship and supportive environment for continual learningRequired Credentials/Experience:Completed Master’s degree in relevant fieldIn progress with BCBA preferredStrong ABA and clinical skillsExcellent written and spoken communication, time management skills, and interpersonal skillsAbility to give and receive constructive feedback with a team player attitudeBilingual skills valuedJob DescriptionIntercare Therapy provides evidence-based behavioral therapies that help children overcome challenges related to autism spectrum disorders. Our mission is to optimize the independence and quality of life of our clients and their families. We love what we do, and we are seeking team members who share our passion for improving the lives of children and families affected by autism.AProgram Managerserves in the field as the onsite case supervisor and leader, mastering daily case management skills, including developing and overseeing clinical programs, supervising BIs and providing education and training for client caregivers. You must be willing to drive 30 to 60 miles a day, andable to supervise client sessions anytime between 8AM and 6PM on weekdays, and occasionally on weekends.We are proud to be the highest rated established ABA organization on Glassdoor! Check out our rankings and reviews on Glassdoor!Learn more about us on You Tube!This position may require the candidate be fully vaccinated for COVID-19 in accordance with all vaccination requirements set forth by Intercare funding sources and pursuant to any guidelines from the California Department of Health.Closing:If you have experience in any of the following fields, we encourage you to apply:Behavior Analyst, Autism, Social Learning, Social Skills, Developmental Condition, Psychology, Sociology, Social Services, Children, ABA, Applied behavior analysis, BCBAIntercare Therapy will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the Los Angeles Fair Chance Initiative for Hiring (Ban the Box) Ordinance.Intercare Therapy supports a diverse workforce and is an Equal Opportunity Employer.

Your Role The Clinical Program Manager, Principal in collaboration with the Regional Medical Director and internal Blue Shield of California teams will be responsible for collaborating with all externally facing partners to transform the way health care is delivered, ensuring best-in-class care for all members. Priority is given to delivering on the Quadruple Aim (lower cost care, increased quality, increased member satisfaction and physician satisfaction) with a focus on execution to drive and accelerate improvements in primary care for all patients. This role will report to the Regional Medical Director. Your work: In this role, you will: Operate at a strategic business level to ensure projects/programs are in line with Blue Shield of California’s strategic goalsConsult with all levels (including senior management) making recommendations and influencing decision-makingLeverage cross-functional internal and external relationships to drive initiatives forwardPlan and implement multiple and extremely complex projects/programs spanning across business areasDetermine key business issues, develop effective action plans, and implement to successful conclusionPerform data analysis for all lines of business: Analyze data in collaboration with Regional Medical Director for trends, drivers, and key initiatives. Incorporate the analysis into meaningful discussions with Group/IPAIdentify opportunities around utilization, quality, and clinical initiatives: Work side by side with internal and external partners in the design and launch of clinical programs focused on high-risk members, hospital initiatives, and behavioral health as well as internal innovation programsPartner with medical groups to co-create programs encompassing a full spectrum of initiatives around disease management, complex care management, transitions of care and site of service; ensuring optimal utilization, access, and quality of care for membersLead with a collaborative approach and an understanding of existing resources and relationships between/among partner organizations while moving them towards constructive changeWork cross functionally with Blue Shield of California internal teams to provide support both ad hoc and for recurrent initiatives Your Knowledge and Experience Requires a current, active California RN, NP, or PA licenseRequires a bachelor’s degree; advanced degree is preferredRequires a minimum of 10 years of prior relevant clinical or job related experienceExperience in case utilization, quality improvement and disease management; MediCal experience is a plus.In-depth understanding of the managed care delegated model and associated efficiency and quality measures. Health plan experience is preferredExcellent verbal and written communication style to drive positive outcomesStrong data analytic skills and advanced knowledge in Microsoft 365, especially in Excel and PowerPoint applicationsAbility to be resourceful and collaborative; a team collaborator with strong listening skills and the ability to offer creative solutions to drive consensus Pay Range The pay range for this role is: $ 136400.00 to $ 204600.00 for California. Note Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles. #LI-EB1

General information City: Van Nuys State: California Team Clinical Services Working time Full- Time Description & Requirements Description Sign-On Bonus:$750Compensation: $26 - $32 Per Hour-Full time, based upon experiencePromotion opportunity to Program Supervisor (salaried) based upon experienceBenefits of Working at Intercare:Monthly Bonuses!Flexible work schedule with a focus on work/life balance; Manage your own scheduleMileage reimbursement, a company computer and cell phoneEducation tuition reimbursement program (Masters & BCBA)!Leadership training and CEUs - we will teach how to become a better leader!Medical, Dental, and Vision insuranceGenerous time off policy (vacation, sick time, and holidays)Company 401k PlanOutstanding mentorship and supportive environment for continual learningRequired Credentials/Experience:Completed Master’s degree in relevant fieldIn progress with BCBA preferredStrong ABA and clinical skillsExcellent written and spoken communication, time management skills, and interpersonal skillsAbility to give and receive constructive feedback with a team player attitudeBilingual skills valuedJob DescriptionIntercare Therapy provides evidence-based behavioral therapies that help children overcome challenges related to autism spectrum disorders. Our mission is to optimize the independence and quality of life of our clients and their families. We love what we do, and we are seeking team members who share our passion for improving the lives of children and families affected by autism.AProgram Managerserves in the field as the onsite case supervisor and leader, mastering daily case management skills, including developing and overseeing clinical programs, supervising BIs and providing education and training for client caregivers. You must be willing to drive 30 to 60 miles a day, andable to supervise client sessions anytime between 8AM and 6PM on weekdays, and occasionally on weekends.We are proud to be the highest rated established ABA organization on Glassdoor! Check out our rankings and reviews on Glassdoor!Learn more about us on You Tube!This position may require the candidate be fully vaccinated for COVID-19 in accordance with all vaccination requirements set forth by Intercare funding sources and pursuant to any guidelines from the California Department of Health.Closing:If you have experience in any of the following fields, we encourage you to apply:Behavior Analyst, Autism, Social Learning, Social Skills, Developmental Condition, Psychology, Sociology, Social Services, Children, ABA, Applied behavior analysis, BCBAIntercare Therapy will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the Los Angeles Fair Chance Initiative for Hiring (Ban the Box) Ordinance.Intercare Therapy supports a diverse workforce and is an Equal Opportunity Employer.

Your Role The Medicare Appeals and Grievances team is responsible for compliance processing of Medicare appeals and grievances. The supervisor will report to the Manager for Medicare Appeals and Grievances. In this role you will manage the daily, short-term, and/or long-term activities of the customer service and operations teams to ensure alignment with service levels and providing service worthy of our family and friends. You will be responsible for the oversight of quality, production levels, strategic initiatives, employee development, preparation and management of budgets, goals, objectives, and results for various operational areas. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially.Your Work In this role, you will: Be responsible for routine operations and people management functionsFoster a great place to work communicating clear roles and responsibilities and building successful working relationships across the organizationConsult and make recommendations to management on operational issuesUse concepts and abilities to manage processes and operations, including procedural changes, inventories, and workload managementApply policies and procedures within health care operationsStay up to date on legislation and regulations to ensure team complianceInterpret audit information requests, prepare narratives, conduct preliminary risk assessments, anticipate adverse findings to prepare for internal corrective action plansMake decisions on people and operational matters consistent with goals and objectivesProvide coaching, performance management, skill development, and guidance on team members’ Professional Development PlansContribute towards achieving the organizations Medicare Stars goalsYour Knowledge and Experience Requires a high school diploma or GEDRequires a minimum of 5 years of prior relevant experienceRequires a minimum of 2 years of experience operating in a lead role or equivalent leadership training or manager trainingKnowledge of Medicare preferred.Experience working with appeals and grievances in healthcare preferredAbility to work collaboratively across diverse teams to improve processes and policies with a focus on the customer experience. Pay Range: The pay range for this role is: $ 66,600 to $ 98,900 for California. Note: Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles. #LI-CP3